Ramblings of an Emergency Physician in Texas

Night Shift Lessons, and Thanks

Lesson: Should you decide to commit suicide by pills and then get into the bathtub, make sure you turn off the water before you pass out. Because, when the tub overflows the downstairs neighbors will, eventually, break down your door, and you’ll come to your ED unconscious, cold, wet, and undead.

Thanks: Overdosing on a mixture of meds almost did you in, especially the beta-blockers: they’re great BP meds at normal doses, but hell when abused. Thanks for letting me have a nice review of tox, 2 pressors and a glucagon drip.

Lesson: Tell people when you go outside to get a smoke late at night, especially when the low is 22F. When you trip, fall, and bang your head into unconsciousness, if nobody comes looking for you your core temp when they find you will be about 70. That is really very cold for a person, and though we’ll spend the next 4 hours rewarming you, the damage is more than done before you showed up, and all the CPR and warmth we can give you won’t be enough.

Thanks: Thanks for letting me put last year’s hypothermia resuscitation talk to use. I haven’t placed a DPL catheter in 5 years, and have never done significant hypothermic rewarming on my own. I’m terribly sorry it was ultimately futile, but you had 10 people working exclusively and hard for you, for hours; thanks for the teamwork and its demonstration.

Comments

Well thank you, GruntDoc. I’m only 42 but childless and not particularly wealthy, so I’ve already started trying to stockpile meds against the day I need someone to oversee my care and advocate for me, and that person does not exist. The trouble is, I don’t have any pharmacology background and don’t really know what to look for. Insulin is good I hear, but you need to be diabetic to get it.

So, beta-blockers, hmm. My family history tends to hypotension so I might never be prescribed beta-blockers myself. On the other hand, my partner has stroke on both sides of the family, so is likely going to have access to the precious exit ticket. Cool.

(Note that I am not suicidal and that I don’t expect to need any of this stuff for another forty years. But it’s good to know about. Reassuring, like. I will have options.)

Here’s another one: Thanks to the patient who ate two cheesecakes a day for 20 years and now weighs over 400 pounds and doesn’t take good care of her diabetes and now I have to place a subclavian catheter in a body that represents the Michelin Man.

My ED attending tells a similar story, back when TCAs were more in use. The variable that determined if you lived or died from a TCA overdose was if you locked your door. He said if it was locked, by the time the cops/firemen got inside, you’d be dead. But if unlocked, they could immediately get paramedics there.

Yeah, BB OD is bad. So is Ca channel blocker. I once had a patient empty 100 dilt capsules in a glass of water and drink it. That’s when I got to learn about high dose insulin as an adjunct treatment for BB OD. Maxed pressors, transcut pacing, glucagon (for kicks), nothing worked. The holidays are hard for some people but we get some interesting OD’s.

You know that saying, “not dead until warm and dead”? I find it in my experience that no matter how cold they are, when they’re dead, they’re pretty much dead and warming a dead body is futile. I wonder if there has been any studies to dispute this saying. Damn, I’m too lazy to do a med search.